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Withdrawing Ventilators in Triage: A Catholic Approach

Withdrawing Ventilators in Triage: A Catholic Approach January 6, 2021

As you may know, I am currently writing a doctoral degree in moral theology. Another priest-friend of mine, Fr. Louis Melahn, LC, is doing the same, but in Rome. He and a few others have taken up the issue of what to do in the case there are insufficient ventilators in an ICU. As ICUs reach 100% capacity with COVID, this might become an issue that comes up in US hospitals. I think Fr. Louis and the other collaborators make a good argument for not removing a ventilator that is still helping someone. The article gets a little academic but is worth the read if you have some background. Below I offer two summaries. One Fr. Louis made for me and the official abstract.

Fr. Louis’s Summary on Triage with Ventilators

Lt. Cmdr. Michael Heimes checks on a patient connected to a ventilator at Baton Rouge General Mid City campus
Lt. Cmdr. Michael Heimes checks on a patient connected to a ventilator at Baton Rouge General Mid City campus (CC BY 2.0 US Navy)

Here’s a summary Fr. Louis sent me that he thought would be more accessible to an average reader:

COVID-19 has sparked fears that hospitals could be critically short in essential resources, such as mechanical ventilators. Fortunately, up to now, critical shortages have been localized, but there are lingering ethical questions.

No one seriously argues that hospitals are in the wrong if they allocate their limited resources as best they can, even if some patients end up without it. Our article instead focuses on something else: could care that is already begun (say, mechanical ventilation) be withdrawn against the will of the patient, in order to give it to someone who would benefit more?

In asking that question, we are assuming that the patient being treated is benefiting from the care. Clearly, there is no particular problem in withdrawing care that is futile or counterproductive—and in fact, it might even be acceptable to override a patient’s unreasonable demands in an emergency.

Our conclusion is that, once care is started, the patient and his caregivers enter into a relationship that entails certain rights for the patient and certain obligations to the caregivers: including the continuing of care, so long as it is reasonably regarded as beneficial.

Deliberately withdrawing such care, and thus provoking the death of the patient, would be a form of direct (that is, intentional) killing and is therefore morally unacceptable—even if the care is withdrawn in favor of patients who would (according to medical personnel’s nest judgement) benefit more.

The Abstract of the Ventilator Paper

Here’s the abstract from the academic journal’s website.

The advent of COVID-19 has been the occasion for a renewed interest in the principles governing triage when the number of critically ill patients exceeds the healthcare infrastructure’s capacity in a given location. Some scholars advocate that it would be morally acceptable in a crisis to withdraw resources like life support and ICU beds from one patient in favor of another, if, in the judgment of medical personnel, the other patient has a significantly better prognosis. The paper examines the arguments for and against this approach from the point of view of natural law theory, especially using the principle of double effect. We conclude that it is inadmissible to withdraw life-saving medical interventions from patients who are still benefiting from them, on the sole grounds that other patients might benefit more. Those who are currently using such technology should only interrupt their treatment if, in the judgment of medical personnel and, if possible, taking into account the wishes and needs of the patient and his family, the treatment is deemed futile, burdensome, or disproportionate.

You can read the whole article for free if you want. I read the whole thing but can’t think of much not covered int he two summaries above.

Hopefully, this helps you understand one of the challenges we face with COVID patients overwhelming ICUs.

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